Tuesday, March 6, 2012

Modifier PT is a HCPCS modifier intended to be used when a scheduled colorectal screening test becomes a therapeutic or diagnostic service. Why would this be needed? Because a screening test has first dollar coverage and a therapeutic or diagnostic test will be subject to co-pay or deductible. Medicare instructs medical practices to use HCPCS codes for colorectal screening (for example, G0105, among others.) But if an abnormality is found and a biopsy is taken or a polyp removed, the surgeon uses a CPT® code in the family of codes starting with 37…. In that case, use the CPT® code, append modifier PT to the service and the patient will not be charged a co-pay or deductible. CMS’s quick reference guide to preventive services states, “No deductible for all surgical procedures (CPT® code range of 10000 to 69999) furnished on the same date and in the same encounter as a colonoscopy, flexible sigmoidoscopy, or barium enema that were initiated as colorectal cancer screening services. Modifier PT should be appended to at least one CPT® code in the surgical range of 10000 to 69999 on a claim for services furnished in this scenario.